Here Comes the Sun — and Melanoma in Its Aftermath


Despite warnings about the dangers of too much sun exposure, men and women in their 20s and 30s are increasingly falling victim to melanoma, one of the deadliest cancers.

We all love sunshine and the healthy glow that enhances our appearances as our skin tone moves from milky white to a handsome tan.

But the cost of that tan could be shattering: Melanoma is one of those diseases no one wants to think about, but it’s out there, considered the No. 1 skin cancer that leads to cancer-related deaths — just under 10,000 deaths a year in the United States alone.

Medical professionals who deal with it daily say they can’t help but be struck by certain patterns over the last few years. “The large number of patients in their 20s and 30s being diagnosed with melanoma surprises me,” reflects Dr. Adam Berger, chief of surgical oncology at Thomas Jefferson University Hospital.

“The majority are people who’ve used a tanning salon a lot, mostly women, but some men.”

By “a lot,” Berger means two to three times a week for six to nine months in a row. The patients he sees are often diagnosed in Stage 2, and while 70 percent can be cured, the remainder will develop metastases in 10 years, he says.

Women tend to present with lesions frequently on the arms and legs while in men, it’s more likely to be on the upper back and chest. And don’t be fooled by the size of a lesion, often identified as a mole that has undergone some peculiar changes.

“Despite being a small lesion, they are deadly, very aggressive — and very concerning,” says Jeffrey Farma, assistant professor of surgical oncology at the Fox Chase Cancer Center.

Farma says melanoma is one of the only cancers whose incidence has been increasing from year to year, and the vast majority are caused by sun exposure, with only a small subset being genetically related.

Most at-risk are people who’ve had multiple blistering sunburns, who’ve patronized tanning salons frequently, who are light skinned and/or freckled and who’ve used oil to help them tan. “What people need to know is that it’s a largely preventable disease,” insists Dr. Anthony Olszanski, director of the medical oncology melanoma group at Fox Chase. “If people avoid excessive sun exposure, use copious amounts of sunblock and sun-protective clothing and avoid tanning beds, the incidence of melanoma would significantly reduce around the world.”

Olszanski has treated a number of patients diagnosed with melanoma in their 20s. “I’ve seen otherwise healthy people die from it,” he says. “Those who survive are destined to live with the anxiety of the diagnosis, the challenges that treatment comes with and the possibility of dying from it.”

While melanoma clearly does not have the same political clout as some of the other cancers — breast cancer and the pink ribbon campaign come first to mind — it nevertheless is a devastating disease, he cautions. “It ranks among one of the highest cancers” when it comes to “life years lost, and a higher awareness of melanoma and the effects of sun damage is critically needed.”

Physicians suggest people follow the ABCDE rule of identifying a potential melanoma. A is for asymmetry; B stands for an irregular border; while C is for color, a really dark pigmentation, or areas that are darker in some parts and lighter in others. D is for diameter and whether or not the lesion is getting wider, while E is for evolution — has the lesion changed in terms of how it looked before?

“Any moles changing or getting darker should be evaluated by a dermatologist,” Farma says. He also advises individuals with higher risk to see a dermatologist annually and get examined from head to toe to identify lesions that should be watched or biopsied.

“If we find the lesions early, there’s a much-decreased risk of it spreading to other areas,” he notes. “Having a relationship with a dermatologist is the smart thing to do.”

Berger cautions individuals to be suspicious of any moles, not just new ones. “If you have a mole that’s changing, it needs to be checked out,” he says unequivocally. “If there’s one you had all your life and it’s starting to change, I would say that’s a melanoma until proven otherwise.”

But if you want to be truly preventative in your approach, re-examine your relationship with the sun, doctors advise. “Wear sunscreen greater than 35 SPF and be cautious about reapplying it every two to three hours to make sure you’re still covered,” Farma says.

Olszanski suggests sun exposure should be in the early morning or late afternoon hours rather than midday, when ultra-violet light exposure is at its highest.

And don’t underrate the importance of UV-protective clothing, because regular clothing does not necessarily protect the skin from the sun’s UV rays, he says.

If there’s any good news associated with melanoma, it’s that there’s been a rapid expansion of new FDA-approved drugs in the last three years — five new drugs approved for patients with Stage 4 melanoma. Immunotherapy is one of the most successful therapies discovered thus far for melanoma, designed to stimulate the body’s natural immune system to recognize and fight the melanoma.

Still, the statistics are sobering. For those diagnosed with Stage 4 melanoma, only 15-20 percent will be alive in five years.

At Stage 1 it’s more encouraging, with a 97 percent survival rate.

South African native Lauren Kramer is an award-winning writer based in Western Canada.


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